Risk Stratification to Reduce Heart Failure Readmissions

Transcription

1 ONRQC April 14, 2014 Risk Stratification to Reduce Heart Failure Readmissions Mary Bedell MSN, ACNS-BC, RN, CHFN Heart Failure CNS Salem Health Details Location: Salem Hospital, Intermediate Care Unit (IMCU) Time Frame: Development- 3 Weeks Implementation- 3 Weeks Evaluation- 4 Weeks Objectives Decrease Heart Failure Readmissions Evaluate High/Low Risk for readmission Arrange Follow up appointment Improve Transitional Care 1

2 Plan for Project Research and select an evidence based risk stratification tool Track heart failure patients throughout their stay on the Intermediate Care Unit On the day of discharge, use tool and evaluate high or low readmission risk Educate patient on follow up and HF education, determine time/day preferences Make follow up appointment according to high or low risk Participant & Roles CNS student- Review charts for HF patients Participate in daily rounding to determine status and needs at transition Risk stratify patient on the day of discharge (DC) (Monday thru Friday only) Contact PCP and/or Cardiology office to schedule appointment Educate patient on follow up and self care parameters during IP stay Background/Available Evidence (Literature review) Two categories: 1. Risk Stratification Tools 16 articles reviewed LACE risk stratification tool chosen Two supporting studies Tested in HF, but can be applied to other patient populations 2

3 Background/Available Evidence (Literature review) Two categories (con t): 2. Appointment made with provider prior to DC 12 articles reviewed Supports early follow up with a provider to decease readmissions Two articles support that the initial visit with Cardiology vs. PCP has a more significant impact on readmissions. Study Description High Risk Patient: LACE score > 10 Cardiology appointment (Not NP or PA) within 7 days of discharge (PCP if no cardiologist following patient) AND PCP appointment within 14 days of discharge Low Risk Patient: LACE score <10 PCP appointment within 10 days of DC Walraven, Dhalla, Bell, Etchells, Stiell, Zarnke, Austin, & Forster, 2010 L + A + C + ++ E = Score Walraven et al,

4 Outcomes Total n= 25 Outcomes Outcomes 4

5 Lessons Learned & Projected Barriers Controversial topic, must proceed with caution PCP vs. Cardiologist Two co-pays for patients in high risk Challenging Implementation: Who, How? Limited time slots in Cardiology and PCP schedules for follow up appointments within the time parameters Good News! Project was implemented on a larger scale for the entire month of March Care management making the appointments 4 units Goal is for all appointments to be scheduled by day 7 post discharge If they were seen by Cardiology: Cardiology appointment set up All other to PCP within 7 days New Risk Stratification tool for inpatients starting soon. 14 Questions? Comments? Thank You! 5

6 References: Ansari, M., Alexander, M., Tutar, A. (2003). Cardiology participation improves outcomes in patients with new-onset heart failure in the outpatient setting. Journal of the American College of Cardiology, 41(1), Au, A.G., McAlister, F.A., Bakal, J.A., Ezekowitz, J., Kaul, P., & Walraven, C.V. (2012). Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164, Dharmaarajan, K., Hsieh, A.F., Lin, Z. (2013). Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. The Journal of the American Medical Association, 309(4), Gheorghiade, M., Peterson E.D. (2011). Improving postdischarge outcomes in patients hospitalized for acute heart failure syndromes. The Journal of the American Medical Association, 305(23), Gruneir, A., Dhalla, I.A., Walraven, C.V., Fischer, H.D., Camacho, X., Rochon, P.A., & Anderson, G.M. (2011). Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using validated predictive algorithm. Open Medicine, 5(2), Hernandez, A.F., Greiner, M.A., Fonarow, G.C. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. New England Journal of Medicine, 303(17), Jessup, M., Abraham, W.T., Casey D.E., Feldman A.M., Francis, C.S., Ganiats, T.G., Yancy, C.W. (2009) Focused update: ACC/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the American college of cardiology foundation/american heart association task force on practice guidelines. Circulation, 119, doi: /CIRCULATIONAHA Metra, M., Gheorghiade, M., Bonow, R.O., Dei Cas, L. (2010) Post discharge assessment after a heart failure hospitalization; The next step forward. Circulation,122; Walraven, C.V., Dhalla, I.A., Bell, C., Etchells, E., Stiell, I.G., Zarnke, K., Austin, P.C., Forster, A.J. (2010). Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. Canadian Medical Association, 182(6),